Annual Review 2006/07

Annual Review August 06 / March 07

The Centre

for cancer care

Trust profile

Contents

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5 Message from the Chairman and Chief Executive

latterbridge Centre for Oncology became a Foundation Trust on August 1, 2006.

It is one of the largest cancer centres in the UK – serving a population of 2.3 million across Merseyside, Cheshire, the Isle of Man and South Lancashire. More than 7000 new patients are treated at the centre each year and we deliver in excess of 120,000 treatments.

Our vision:

6 Locally accountable 8 The first choice for patients 12 The first choice for staff

The main treatment facility, which includes radiotherapy, chemotherapy, diagnostic imaging and support services is located at the Clatterbridge Hospital site in Wirral. However, the Trust also provides visiting medical and nursing teams to hospital sites throughout the region to deliver further specialist cancer services.

6 Pioneering in research and 1 development

The treatment centre has undergone significant financial investment over the past five years and now hosts one of the best equipped radiotherapy centres in the UK.

31 The financial report

Research and development, including participation in national and international clinical trails, is also an important feature of the cancer centre.

41 Trust information

21 Delivering safe and effective services 27 Performance

39 Meet the Board

44 Acknowledgements and contatcs 45 What our patients say

‘To be a high quality world class provider of cancer care to cancer patients.’

Our Service Development Strategy sets out how we will make our vision a reality. We aim to be: • • • • •

Locally accountable The first choice for patients The first choice for staff Pioneering in research and development Delivering safe and effective services

Clatterbridge Centre for Oncology

Annual Review 06 / 07

Reading through this year’s Annual Review it clearly demonstrates that everyone working at Clatterbridge Centre for Oncology is extremely passionate about the services that it delivers for patients.

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uite simply, we want to be a world class provider of cancer services and the first choice for patients in need of treatment.

Darren Hurrell, will be joining us from Stockport NHS Foundation Trust, where he is currently the Director of Service Modernisation.

Over the last eight months our healthcare professionals have continued to be innovative in their approach to work and are well respected for their commitment to research. We are one of the most active hospitals in clinical trails for cancer patients anywhere in the country.

Looking ahead to 007/0 , maintaining our financial stability and continuing to address key performance targets, such as the 6 day target and the 1 week patient pathway, will be crucial to our success. We will also be focusing our energies on expanding and delivering more of our services in the local district general hospitals across the region.

Our radiotherapy equipment now includes some of the most modern machinery in Europe and our waiting times for this treatment are currently recognised as among the best in the country. Within the last year, patients have faced an average wait of 1 days for radiotherapy treatment and just under 100% of our chemotherapy treatments begin within 1 days.

With the fast pace of NHS reform and the new era of patient choice, we cannot afford to rest on our laurels. We encourage an ethos of service improvement at all levels within the organisation and over the coming months we expect our staff to take an active role in bringing about further changes for the benefit of our patients.

From the moment a patient or visitor walks through the front doors to the centre, our staff and a network of dedicated volunteers will do everything within their power to help, reassure and make the hospital experience as comfortable and efficient as possible.

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Clatterbridge Centre for Oncology

Chief Executive Tony Halsall left the organisation in February 007 and we wish him well in his new post with Morecambe Bay University Hospital Trust. Our new Chief Executive

Alan White Chairman, Clatterbridge Centre for Oncology NHS Foundation Trust

Andrew Cannell Acting Chief Executive

Message from the Chairman and Chief Executive

MessaGe frOM the ChairMan anD Chief eXeCutive

As a Foundation Trust hospital we have a clear vision, set out in our Service Development Strategy, about where we want to be five years from now. With the support of our recently established Council of Governors we have high hopes and expectations about what the future holds. Financially we are stable and pleased to report a surplus of more than ÂŁ1.7m within the last financial year.

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Meet Governor Tom Fisher and find out more about his role…

lOCallY aCCOuntaBle

Within the last eight months the Council of Governors has already fulfilled a number of its new statutory functions, such as the appointment of a Non Executive Director and the appointment of the Trust Auditors.

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latterbridge Centre for Oncology became a Foundation Trust hospital on August 1, 006, which means that it has new levels of accountability to the local community. Part of this change has seen the formation of a new Council of Governors, made up of elected representatives from the whole region.

Our Governors have established four committees and are already working with the hospital on a range of projects and initiatives: • The Patient Experience Committee is currently involved in reviewing patient information and progressing plans to furnish the ‘quiet room’ for patients.

• A Membership and Communications Committee is developing plans to engage with existing members and attract more members. They have also introduced a scheme to link elected Governors with a member of staff in a service area of interest – to improve understanding about their roles.

• The Fundraising Committee is supporting the work of Clatterbridge Cancer Campaign. The committee has actively sought representation on the Board of Trustees for the charity.

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Clatterbridge Centre for Oncology

• A Strategy Committee is reviewing and supporting us in our service development plans.

The Council of Governors want to ensure that cancer services are developed in a way that reflects the needs of local people.

As Governors, they are available to visit community groups, local businesses and other organisations to explain more about the work of the centre.

The hospital is also encouraging local residents to show their support for its work by registering to become a Foundation Trust member. Members receive regular news updates about the hospital and are invited to take part in consultation plans aimed at improving services.

Any groups or individuals who would like to learn more about Clatterbridge Centre for Oncology and the role of the Council of Governors can telephone 0151 482 7799 or visit our website www.ccotrust.nhs.uk.

lected to represent Wirral, Wales and the rest of England, Governor and local solicitor Tom Fisher shares his thoughts about the new role and the transition to the Trust being a publicly accountable organisation.

Tom Fisher has had treatment for cancer for the last seven years. He explains: “During this time I have had invaluable support from Clatterbridge Centre for Oncology and I decided to put myself forward as a Governor as I wanted to reciprocate this support.

“To help me deal with my cancer I sought out knowledge and information – and I wanted the opportunity to encourage other patients to do the same. I also believe it is important that the views and opinions of the local communities relating to the Trust are heard and are taken into account. The main function of the Governors is to ensure local accountability and to keep an eye on the strategic direction of the organisation as well as looking at things from the patient perspective.”

Tom is involved with the newly established Patient Experience Committee as well as the Remuneration and Appointments Committee. He says: “I enjoy being a member of the Patient Experience Committee. We review patient survey results and highlight areas to work on. Recently the group has been working with Patient Forum and Patient Council on a food

watch project looking at the provision and nutritional value of the food that the hospital provides for the patients.

“Particularly interesting for me was my involvement as a member of the Appointments Panel. In November and December 006 this panel undertook the recruitment and recommended the appointment of a new Non-Executive Director to the Trust.

“I’ve also had a role in recruiting the new Chief Executive.

The process was thorough to say the least. I attended the presentations given by each of the candidates and had the opportunity to ask questions and thereafter gave feedback.

I was able to meet candidates informally at a dinner at Thornton Hall which was quite an advantage. The next day I was a member of the six person interview panel again giving me the opportunity to raise further questions of the candidates. This was particularly worthwhile.”

Tom adds: “The NHS Foundation Trusts are a completely new kind of NHS organisation. These are about the NHS being run locally by local people rather than by politicians in central government. Accordingly local people now have a real say in the running of their local hospital. As a Governor I am proud to provide a link between the local people and the hospital.”

Annual Review 06 / 07

Locally accountable

Governors get involved with the centre

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The first choice for patients Major investment in new equipment

total of £5 million has been invested in new equipment and improving the services for the benefit of our patients over the last year.

In the Radiotherapy Department our oldest Electa linear accelerator has now been replaced with a £910,000 machine from Varian. Our ninth and newest accelerator, known in the hospital as the V10-4, became operational in January 2007. This followed a four month installation project involving staff from Technical Services and Physics. The treatment room has been reconfigured and redecorated to suit the new requirements of the machine.

Two new Computerised Tomography scanners (CT-scanners) have also been purchased by the Trust. Each scanner costs approximately £500,000.

A new CT scanner in Diagnostic Imaging will play a vital role in staging the disease, which means it helps identify the extent of cancer within the body, especially if it has spread from the original site to other parts of the

body. CT scans are also used to monitor the progress of patients throughout their treatment. Previously Diagnostic Imaging had a single slice spiral scanner, but this has been replaced with a multi-slice spiral scanner.

This is able to acquire more than 64 ‘slices’ in one rotation at high speed, as opposed to one ‘slice’.

Hundreds of images are generated and when these are reassembled by computer, the result is a very detailed, multidimensional view of the body’s interior. This equipment was delivered in March 2007 and is expected to be operational in June 2007.

The Treatment Planning team in Radiotherapy has welcomed the installation of a second wide bore scanner. As linear accelerators are capable of more sophisticated treatments, imaging during the planning stages needs to be performed with the patient in the same position to enable radiotherapy to be targeted more effectively at the tumour.

The wide bore scanner also provides a better experience for larger patients or those who are claustrophobic.

A new initiative at Clatterbridge Centre for Oncology is creating a real buzz among patients. Vibrating and bleeping pagers, similar to those used in themed restaurants, are being issued to patients. The Trust is believed to be among only a handful of hospitals in the Northwest making use of this latest technology.

S Scans on this equipment are also faster for the patient.

Acting Chief Executive Andrew Cannell said: “With such significant investment in equipment over the last few years, Clatterbridge Centre for Oncology now boasts some of the most modern radiotherapy treatment facilities anywhere in Europe. By keeping abreast with the latest developments in technology, our doctors and radiographers are in a strong position to provide cutting edge treatments.”

“By keeping abreast with the latest developments in technology, our doctors and radiographers are in a strong position to provide cutting edge treatments.”

ometimes patients arriving for treatment at the hospital experience a short wait between seeing their consultant, having their blood counts checked and starting chemotherapy treatment.

The new pager service is now available for patients who want the freedom to go for a walk or have a cup of coffee whilst waiting for their name to be called for an appointment. This offers an alternative to sitting in the designated waiting area.

On request, receptionists can now take patient details and issue a small plastic baton, which is a pager. The baton buzzes, bleeps and flashes to attract attention when the doctor or nurse is ready to see the patient. It is suitable for people who are deaf or visually impaired. They even include a special alarm system that activates when a

pager is lost to attract attention.

A total of 40 pagers are now in use at the centre. They are being trialed in the outpatients department and on the Delamere day ward, where patients go for chemotherapy. The system has cost £5000 to install and has been made possible thanks to charitable funding.

Ward manager at Delamere chemotherapy unit Carol Gregson said: “The pagers are straightforward for both staff and patients to use and are proving extremely popular. We’re still treating the same numbers of patients, but the waiting area is now a lot quieter as people have greater flexibility to wander around the hospital and surrounding grounds.

– as they’ve had the opportunity to get some fresh air, sit out in our gardens, rest in the patient lounge and enjoy a hot meal or a cup of coffee from the hospital restaurant.”

Director of Healthcare Governance Helen Porter added: “We pride ourselves on our innovative approach to improving services at Clatterbridge Centre for Oncology for the benefit of our patients and staff.

“We’ve worked hard to revamp and upgrade patient facilities in recent years, and these pagers give more people the opportunity to make the most of the services that we have on site.”

The first choice for patients

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New pager system creates a buzz among patients

“Patients are arriving for appointments in a much more relaxed frame of mind

Andrew Cannell, Acting Chief Executive

Clatterbridge Centre for Oncology

Annual Report 06 / 07

HeadStrong

Cocktail hour creates a stir

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MacMillan cancer support survey identified that one of the main areas of concern for cancer patients was hair loss. As a result HeadStrong was established as a free advisory service to provide information and support on an individual appointment basis to anyone who has lost, or is likely to lose their hair as a result of cancer treatment.

Six volunteers from Clatterbridge Centre for Oncology have now been professionally trained by Breast Cancer Care to deliver this inspirational service to our patients. Advice on how to look after their hair and scalp before, during and after treatment is provided and lessons in scarf-tying techniques with opportunities to try on hats, scarves and hairpieces is offered.

C Losing hair as a side effect of cancer treatment can affect confidence and cause many people to feel insecure about the way they look. HeadStrong not only helps to increase self-esteem, it teaches the practical techniques needed to cope with this difficult side effect.

Ann Turtle from the on site MacMillan Information Centre said: “This service is invaluable and has proved very popular – the practical advice is precious to patients to help them overcome this side effect but more importantly gives them an opportunity to feel comfortable and confident. Psychological support and encouragement about body image is vital to help patients just feel normal again.”

latterbridge Centre for Oncology has scored amongst the best performing NHS Trusts across England according to the Healthcare Commissions in-patient survey for 2006.

rated their experiences with medical staff. Confidence in consultants and nurses at the Trust was shown to be among the best results in the country.

Cleanliness of the hospital wards A total of 850 former in-patients were and facilities was recognised as of an approached to take part in the survey excellent standard. Responses also and 58% responded. Data collected showed the hospital to be extremely from 95% of respondents saw the centre effective in its admission procedures scoring within the country’s 20% best – with experiences of waiting times performing Trusts. for admission to hospital and onto wards being significantly positive.

The survey is aimed at understanding Areas identified for improvement in the what patients think about the care year ahead include providing a wider and treatment they receive. It is crucial choice of admission dates and reviewing to improving the quality of care being the proportion of patients receiving a delivered by the NHS. copy of the clinical letters sent to General Practitioners.

Clatterbridge Centre for Oncology scored particularly highly for the way patients Acting Chief Executive Andrew Cannell

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Clatterbridge Centre for Oncology

Traditional favourites like pina coladas, cosmopolitans and margaritas have been replaced with nutritional alcohol free appetizers at the centre.

Healthier alternatives such as ‘strawberry sunshine shake’, ‘fruit fizz’ and ‘banana dream’ give patients the opportunity to enjoy their usual nutritional supplement drinks blended with ice cream, fresh fruit, yogurts or lemonade.

Dietitians have devised a special service and drinks menu at the hospital to help patients increase their calorie intake to help regain their strength and their appetite.

Top marks in patient survey C

alls of ‘shaken not stirred’ aren’t what you would normally expect to hear on a hospital ward, but cocktail hour at Clatterbridge Centre for Oncology is proving a big hit with patients.

said: “It is hugely reassuring to receive such a high level of feedback from our patients. Our staff place patients at the centre of everything they do, and this fantastic response is a credit to all their hard work. However, we are not complacent and will used the results of this survey to inform further service improvements.”

20% Clatterbridge Centre for Oncology scores with the country’s best performing Trusts

Happy hour is every Monday afternoon, when the dietetic support nurse and a volunteer take to the wards with their colourful cocktail shakers and serve up their exotic concoctions.

environment as comfortable and as pleasant as possible for our patients.

“It is inevitable that some of the patients being treated for cancer feel poorly and go off their food. It is our job to be as creative as possible in encouraging them to start eating properly again and stop weight loss.

“When people see this colourful cocktail trolley being wheeled around the wards it offers a break from normality, generates interest and always raises a few smiles.

“Nutritional supplement drinks aren’t much fun when you are having them day-in, day-out. But it is amazing the difference you can make to the flavour and appeal by adding fresh fruit or ice cream and presenting them in an attractive way.

Barbara added: “We make sure that any visiting friends and relatives are offered a taster. And when they ask if we can give them the recipe, they get full set of instructions on how they can recreate these drinks at home.”

As you’d expect with any cocktail service, the drinks are served up in fluorescent martini glasses and decorated with an umbrella and fresh fruit – making them all the more appealing to patients.

The nutritional supplement drinks included in the cocktails are usually milkshake style drinks or powders for mixing with milk, and there are varying brands on sale in supermarkets or chemists. Juice versions are also available, some by prescription only.

The menu changes throughout the year, with themed cocktail hours in the run up to Halloween, Christmas or Valentine’s Day.

Cocktail hour has proven such a success, Clatterbridge Centre for Oncology is now planning to expand the service, and run it more frequently.

“When people see this colourful cocktail trolley being wheeled around the wards it offers a break from normality, generates interest and always raises a few smiles.”

Barbara Deeley, Dietetic support nurse

The first choice for patients

Volunteers at Clatterbridge Centre for Oncology have teamed up with Breast Cancer Care to be one of a few hospitals in the UK to offer patients their HeadStrong advisory service.

Dietetic support nurse Barbara Deeley said: “We want to make the hospital

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valuable service is now being provided to Clatterbridge Centre for Oncology’s staff and their family household members to offer professional on-line, telephone and face to face support for a range of personal and work related issues that can impact on stress levels.

The scheme is aimed at providing support and help for employees to alleviate high levels of stress – both at home and in work.

A 4-hour telephone help line is in operation and support is now available for issues such as child care, debt advice, elder care, face to face counselling, telephone counselling, financial information and legal advice.

Director of Human Resources at the Trust Dawn Jennings said: “As an employer, we take our responsibilities for looking after the wellbeing of our workforce extremely seriously. We recognise that problems outside of work can have an impact on our actions whilst in work, and we feel it is crucial that staff are supported both in and out of work.”

the first ChOiCe fOr staff Workforce strategy T

he Trust’s current workforce strategy was developed during the Foundation Trust application process, placing emphasis on four key developmental areas:

A detailed action plan was developed to underpin delivery of the goals outlined within each of these areas.

Achievements during the first year include:

• • • •

• Achievement of ‘Practice Plus’ status of the Improving Working Lives standard • Delivery of the Agenda for Change project • Establishment of a Performance and Development Review process for all staff

Partnership working Recruitment and retention Talent management Innovation and modernisation

• A revised, streamlined recruitment process, incorporating e-recruitment • Development and launch of a revised Corporate Induction Programme • Introduction of an Employee Assistance Programme • A redesign of the system for funding Learning and Development activity • Development and launch of a Communications Strategy • Implementation of a policy for managing Organisational Change

Top scores for staff survey

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esults from this year’s Healthcare Commission annual staff survey show the centre continuing to score within the top 0% of hospital trusts nationally.

The introduction of the service was prompted in response to the 005 annual staff survey, after 40 per cent of respondents said they believed work related stress was an issue in the workplace. The 006 survey results have now shown a 10% reduction in this figure.

“There have been a lot of changes to the structure of the Human Resources team within the last year.

We are now in a position to take a much more proactive role in looking after and developing our staff.”

Dawn Jennings Director of Human Resources

Improvements have been identified in the staff appraisal process with the survey returning a rise in the number of staff being appraised and implemented with specific personal development plans.

A total of 57% of employees responded to the 006 survey. The findings show significant improvements on last year’s survey.

The first choice for staff

Employee Assistance Programme helps staff

“Our workforce strategy is aimed at the Trust getting the right people, with the right skills, in the right place at the right time.”

Dawn Jennings, Director of HR

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Clatterbridge Centre for Oncology

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New learning prospectus

Encouraging a healthy workforce

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he next year will see the publication of a new Trust-wide Learning and Development Prospectus.

Encouraging job satisfaction and a healthy workforce is a priority at Clatterbridge Centre for Oncology.

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ith this in mind the Human Resources team set out at the beginning of 2006 to provide a series of health promotion days. These were supported by the Occupational Health service provided by Wirral Hospital Trust.

The initiative was aimed at providing staff with information on living a healthy lifestyle with the ultimate goal of ensuring our workforce is well and happy.

The events took place in February and March and saw staff being given advice and support from staffing groups across the Trust, these included: • Cholesterol and blood pressure checks • Dietary advice • A workshop on how to avoid stress

• Relaxation sessions • Hand massages provided by our volunteers

The prospectus details in one place all of the formal learning and development events that exist across the centre.

It will be a valuable resource in promoting the sharing of knowledge and expertise across departments, whilst helping to communicate more effectively the opportunities on offer.

Human Resources’ Learning and Development Advisor Chris Lloyd said: “Pulling together this prospectus has

“We pride ourselves on keeping up to date with the latest techniques and technologies for treating our cancer patients.”

Angela Heaton, Research Radiographer

been a major challenge for the Learning and Development Working Group.

Over the last six months we have been busy encouraging departments to contribute by identifying any training and development related events that they can

offer to colleagues across the Trust. It is due to be published in May and we hope that the benefits of this documented resource will be instantly recognisable.”

Director of Human Resources Dawn Jennings said: “There have been a lot of changes to the structure of the Human Resources team within the last year. We are now in a position to take a much more proactive role in looking after and developing our staff.

“These health promotion days are about ensuring that we all make some time for checking our blood pressure, understanding the importance of relaxation, a healthy diet and protecting our wellbeing. They’ve been extremely popular and plans are already underway for similar events over the next year.”

Improving learning and development opportunities ignificant inroads have been made over the last year in learning and development. It has been a busy year for the Clinical Education Team, attracting interest from doctors, nurses and other healthcare professionals working both at our centre and in other hospitals across the region.

MacMillan Lecturer Debbie Wyatt manages the facility. She explained: “We don’t offer degree courses here,

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but we have strong links with Chester University and Liverpool University and we run a number of courses that are validated by these establishments and form part of a degree.

“With the growth in chemotherapy services, we have experienced a high demand for the courses we run on ‘Care of the Patient Requiring Chemotherapy’.

As well as degree modules the centre also runs short courses for any staff who want to develop their knowledge, skills and expertise in cancer care. These include courses on communication skills, an introduction to cancer and one day visits to the centre.”

The first choice for staff

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Lung cancer patients benefit from new radiotherapy treatment A new radiotherapy treatment is enabling doctors and radiographers to target lung cancer tumours with improved accuracy at Clatterbridge Centre for Oncology.

he hospital is among only a handful of cancer treatment centres in the world to trial the use of a new technique for lung patients known as respiratory gating.

In the past patients have been treated using larger treatment volumes to take account of the motion of the tumour as the patient breathes in and out. The large irradiated volumes of normal lung limit the dose that can be delivered safely to the tumour, subsequently reducing the chances of a cure.

The new technique times or ‘gates’ the bursts of radiation therapy to a fixed interval in the breathing cycle. This freezes the tumour position and enables a much smaller volume to be treated – allowing doctors to deliver a higher dose to the tumour and increase chances of a cure.

piOneerinG in

researCh anD DevelOpMent

Gating is done using a small plastic box, about the same size as a matchbox, which sits lightly on the patient’s chest.

It contains light reflective markers that link to cameras in the treatment room and the linear accelerator’s computer system, which triggers the radiotherapy beam on and off.

A course of treatment usually consists of up to 0 sessions of 1 minute radiotherapy sessions over a period of four weeks.

Within the last 1 months four patients have been treated using respiratory gating at the centre.

This technique and its associated research is currently the subject of much international discussion and interest.

Last year Clatterbridge Centre for Oncology’s Research Radiographer Angela Heaton was approached and funded

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by the Australian Government to present her findings to key radiographers and clinicians in their country.

She said: “We pride ourselves on keeping up to date with the latest techniques and technologies for treating our cancer patients.

“As the rib cage moves up and down when we breathe, so too does any tumour. As radiographers we need to be as precise as possible when treating the patient. This technique enables us to be more targeted by timing the beam to activate at the same point in the breathing cycle for each breath.

“The simplicity of the equipment used is appealing to the patients and results show that by being more targeted with the radiotherapy beam, they develop fewer side effects.”

Consultant Clinical Oncologist Dr John Littler added: “Respiratory gating will make radiotherapy possible for some patients who couldn’t safely be treated using older techniques. For some lung cancer patients it will offer a safer, effective and more tolerable option.

“It may also allow us in time to increase the dose to the tumour, because it will cause less damage to the surrounding normal lung tissue.”

The centre hopes to set up a gating school for medical professionals throughout the UK later this year.

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Pioneering in research and development

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Major funding awarded to support Trust physicist

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r John Fenwick worked at the Trust from 1 to 00 and returned in 004 after spending a couple of years at the University of Wisconsin-Madison. Last year he submitted an application to the national charity for a Career Development Fellowship. These fellowships are awarded to outstanding cancer scientists at the start of their independent careers. As part of the application process, John submitted detailed plans for his research work and attended an interview in London.

The grant funds John and an additional research physicist, together with some technical support, to work on the following research program: • A collaboration with other cancer centres in Glasgow, Cardiff, Sheffield, and Guys and St Thomas in London, assessing the efficacy of dose escalated radiotherapy treatments for non-small cell lung cancer patients.

• A study carried out in collaboration with researchers at Guys and St Thomas, Nottingham and Madison, using advanced scanning techniques to image cell proliferation and blood flow in tumours, exploring whether high-precision radiotherapy techniques can be

used to specifically target rapidly-proliferating and poorly oxygenated tumour regions.

• A mathematical biology-based analysis of the effects of radiation doses and timings on radiotherapy reactions in rapidly turning-over normal tissues such as oral mucosa, looking to see whether higher doses can be safely delivered using innovative treatment schedules.

• Development of Intensity Modulated Arc Therapy – changing the way radiotherapy is delivered to better exclude normal structures from high dose regions.

Reflecting on his success in securing the funding John said: “I’m really pleased to receive this award. A lot of people put a lot of effort into raising money for Cancer Research UK, and now I have a huge responsibility to make these projects happen. This is quite a large project, and very live science – so a big challenge will be to adapt plans when things don’t work exactly as expected.” He added: “Clatterbridge Centre for Oncology originally funded and developed my post. This case shows that investing in people really can work, and make a difference for the benefit of the organisation.”

Rectal cancer developments attract international interest D

octors and radiographers from around the world visited Wirral this year to learn more about a pioneering cancer treatment being developed at Clatterbridge Centre for Oncology.

The centre is carrying out trials on a new technique that sees radiotherapy delivered internally, using a beam of radiotherapy aimed directly at the tumour that targets the tissues needing treatment. In the past only external radiotherapy treatments have been common practice.

The treatment, known as Brachytherapy or ‘Contact Radiotherapy’, can be used to treat patients with early stage rectal cancer before surgery. In cases where the tumour is operable, the technique has brought about improved results.

It also offers an alternative for people with rectal cancer who are not fit for surgery, don’t want to undergo surgery or want to avoid having a colostomy bag.

Clatterbridge Centre for Oncology is the only UK cancer hospital currently offering patients the choice of Brachytherapy for rectal cancer.

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The technique has been developed in this country by Dr Sun Myint, who has been collaborating with medical colleagues from cancer hospitals in Amsterdam and Montreal.

More than 50 people from the Merseyside and Cheshire area are diagnosed with rectal cancer every year and receive treatment from Clatterbridge Centre for Oncology.

Across the UK, over 10,000 cases are reported each year.

This particular technique isn’t suitable for all patients, but so far 5 people have been successfully treated in Wirral using this method.

More than clinicians, physicists, radiographers and specialist nurses attended a two day workshop hosted

by Clatterbridge Centre for Oncology in September. The guest speakers included Dr Te Vuong from Montreal hospital, Dr Corrie Marijinen from Amsterdam and Wirral’s Dr Sun Myint who demonstrated the technique.

It is hoped that national and international trials will be established over the coming year after more healthcare professionals are trained in using the technique.

Dr Myint explained: “Here at Clatterbridge Centre for Oncology we are committed to researching and developing best practices in radiotherapy treatment for the benefit of our cancer patients. This technique enables us to give a higher dose of radiotherapy to the immediate area around the tumour without exposing surrounding healthy tissue to the effects of radiation and toxicities.”

Physics textbook leads the way T

he most comprehensive textbook ever to be published about radiotherapy physics was released this year – and two of our very own members of staff have played a major role in its development.

Head of Physics Dr Philip Mayles and Professor Alan Nahum have co-edited a ‘Handbook of Radiotherapy Physics: Theory and Practice’ together with Jean-Claude Rosenwald from the Institute Curie in Paris, France. Philip and Alan have been working on the project for more than seven years.

It is anticipated that the textbook will be used by physicists and radiation oncologists throughout the world.

It is also hoped that it will become the recommended reading for many university courses on medical physics across the globe.

“Preliminary results have been very encouraging and it is a real possibility that is type of treatment will become a national standard in the near future.

We know the technique works, but we are now in the stages of demonstrating to other specialists that it works and encouraging them to join in our trials, which in turn will benefit their patients.”

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Pioneering in research and development

Cancer Research UK has awarded almost £ 00,000 to a physicist at Clatterbridge Centre for Oncology, funding six years lung and head-and-neck radiotherapy research.

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DeliverinG

safe anD effeCtive serviCes

A £1.4 million project has seen a new system installed that sees all of our X-rays and scans stored electronically.

Nursing conference promotes best practice in cancer care Hundreds of nurses descended on Chester in January for a major national cancer care conference.

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he event, organised jointly by Clatterbridge Centre for Oncology and the Royal College of Nursing, provided an opportunity for healthcare professionals to come together and share best practice about innovative treatments in cancer nursing.

More than 1 0 key figures from cancer nursing attended the conference entitled ‘Together against Cancer’.

Guest speakers covered a range of topics at the event including developments in prostate cancer treatments, how nursing teenagers can be different, the patient

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Clatterbridge Centre for Oncology

experience of a community palliative care team and South Asian women experiencing cancer.

The hospital is recognised as a centre of excellence for cancer care and Director of Healthcare Governance, Helen Porter, helps to organise the event and Chairs it every year. Speaking about the conference Helen Porter said: “At Clatterbridge Centre for Oncology we see this event as a real opportunity to share information about key aspects of nursing research and developments over the last twelve months.

“Nursing cancer patients is rewarding yet challenging work. Often we are

not only dealing with a patient’s medical requirements – but there are also spiritual, emotional and social concerns that we need to be able to respond to.

“This conference addresses the new challenges and opportunities facing cancer, such as advances in medical technologies, new drugs, rising expectations amongst the public and the changes to patient choice and commissioning of cancer services.

The event is now in its thirteenth year – and is attracting more and more interest. Plans are already underway for the 00 event.”

The installation of a Picture Archiving and Communications System (PACS) is a national led Department of Health project, being implemented throughout the NHS.

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mages can now be stored electronically and viewed on video screens, so that doctors and other health care professionals can access the information and compare it with previous images at the touch of a button.

The system went live at the end of March, following months of detailed planning and training. The Trust has invested in specialist PACS software and state of the art equipment to support the new system. This includes a range of PACS screens deployed throughout the centre.

“Fewer unnecessary re-investigations, which will in turn reduce the amount of radiation to which patients are exposed.”

Benefits of the new system include: • Faster delivery of medical images to the clinicians that evaluate and report on them. This can lead to speedier availability of results.

• No lost or misplaced images, which means fewer patients being postponed or cancelled for consultations or operations due to images not being available.

• Flexible viewing with the ability to manipulate images on screen, which means patients can be diagnosed more effectively.

• Instant access to historic images and patient records.

• Better collaboration, as PACS can be viewed from multiple terminals and locations by a range of clinicians, allowing discussion over diagnoses.

• Fewer unnecessary re-investigations, which will in turn reduce the amount of radiation to which patients are exposed.

Annual Review 06 / 07

Delivering safe and effective services

New Picture Archiving and Communications System

1

C

N

Last August the Healthcare Commission announced that the treatment centre was one of only 18 hospital trusts in the country to be given top marks in its annual medicines management healthcheck.

Much work has been done by the hospital to improve its pharmacy services over recent years.

More than £1.7m has been invested in a new state-of-the-art pharmacy for the preparation of chemotherapy drugs and additional staff have been recruited to support the development of the service.

Clatterbridge Centre for Oncology has received recognition for its high standards of patient care as part of a prestigious independent assessment.

Acting Chief Executive at Clatterbridge Centre for Oncology Andrew Cannell said: “We are pleased to see that our performance in medicine management has been recognised as excellent at a national level.

“Our pharmacy team has been working closely with patients to give them a greater understanding of their medication and reduce wastage from unnecessary prescriptions.”

“This high rating from the Healthcare Commission demonstrates the commitment of all our healthcare professionals in working together to manage medicines safely for patients.”

T

but this is the first time the award has been given across all departments.

The widely acclaimed ISO 9001:2000 standard is based around the principles of customer satisfaction, a systematic approach to management and encouraging a culture of continual improvement.

Acting Chief Executive at Clatterbridge Centre for Oncology Andrew Cannell said: “We take our responsibilities for providing a high standard of patient care extremely seriously.

We are always looking for new and innovative ways in which we can bring about further service improvements for the benefit of patients and staff.

• Excellent progress has been made in managing and reducing infection.

“Our success in gaining this accreditation is a credit to the work of our staff in making sure that we have the processes in place to meet and exceed patient expectations.”

• The Trust has embraced guidelines from NICE (National Institute for Health and Clinical Excellence) recommending medications in the patients’ best interests.

he region’s leading cancer treatment centre is believed to be the only hospital in the UK to be awarded the British Standards Institution (BSI) quality management standard across all departments.

To achieve the accreditation staff at the hospital demonstrated meeting strict criteria in giving their patients the best possible care. The Trust also showcased the quality systems it has in place to ensure improvements continue.

Clatterbridge Centre for Oncology was accredited in 1998 with BSI for ISO 9001:2000 in its radiotherapy department,

Clatterbridge Centre for Oncology

High performing areas identified in the assessment include: • Patients are educated and encouraged to administer their own medicines.

• The pharmacy team is proactive in promoting best practice for medicine management across the Trust.

ew equipment is being used in the mould room to help doctors and radiographers target tumours in head and neck patients with more accuracy.

The section has invested more than £16,000 in eight carbon fibre and two Perspex five-point fixing boards that reduce the risk of movement in patients during treatment. In the past mould room radiographers have been using a two-point Perspex fixation board. The patient lies back on this board for treatment, and a specially moulded mask is placed on top and locked into position at either side of the face to restrict any movement.

The new boards serve the same function, but they further secure the position of the patient by locking the mask into place at the top of the head, either side of the face and on each shoulder. They also overhang the edge of the bed so as the linear accelerator can rotate around the head if needed, and as some of the boards are made of carbon fibre, they don’t absorb the radiotherapy beam as much as the present system.

Four permanent senior radiographers, one rotational radiographer and two technicians work in the mould room. They see up to 15 patients a day and are involved in all aspects of pre-treatment for head and neck patients – creating masks to fit and marking them up, overseeing treatment simulation and scanning, helping with dose calculation and computer planning and attending the first treatment on the linear accelerator if needed.

Mould room staff have spent the last two years testing a variety of boards and suppliers.

They opted for an American design made

by Q-fix, after finding it easier to use, comfortable for patients, adaptable and more durable. Senior 1 Mould Room Radiographer Louise Wait explained: “Treatment techniques are becoming more sophisticated and we can now target tumours with greater precision.

However, this also means that we need to be more confident in our immobilisation and by using a five point fixing board, we will be able to achieve greater accuracy and reproducibility.”

Annual Review 06 / 07

Delivering safe and effective services

latterbridge Centre for Oncology has been independently rated as ‘excellent’ for its work in prescribing and dispensing drugs safely to patients.

Prestigious award recognises our quality of services

22

Safe management of medicines

More accuracy for targeting tumours

23

lOOKinG fOrWarD: Our plans for the future T

Delivering our future Cancer care is a rapidly changing service environment.

Our organisation needs to be flexible and at the same time have systems and processes in place allowing adequate assessment of the potential developments or clinical changes.

Continuing to be the first choice for staff Continuing to be the first choice for patients C

latterbridge Centre for Oncology supports the emergence of a culture of patient choice and recognises that in order to facilitate this there must be plurality of provision. Our forward plans are designed to position us, whatever the competition, as the provider of choice for patients requiring radiotherapy or chemotherapy within Cheshire and Merseyside.

Plans for radiotherapy The radiotherapy service will demonstrate significant change over the next five years and it is anticipated that treatment numbers will rise.

• The radiotherapy department will implement a new structure, which includes the development of advanced practitioner and consultant practitioner roles. There is an opportunity for them to take over functions currently performed by consultant oncologists, such as review clinics. This is part of a broader corporate service plan to reduce the current level of work intensity for consultant staff.

• An additional linear accelerator has recently come on line, providing an additional 10 hours per day of treatment time.

• A linear accelerator replacement programme is built into capital expenditure plans at 10 years of age.

• A feature of the vision for the future of the hospital is the provision of a satellite radiotherapy service, to reduce the travel times for patients from the North of the Mersey.

4

Clatterbridge Centre for Oncology

Plans for chemotherapy Chemotherapy services are dependent on technical expertise for safe delivery and there is a national guidance directive that this service should be delivered from either a cancer centre or cancer unit. This has led to the centralisation of chemotherapy services to a centre like our own. However, in looking to the future we must prepare for increasing pressure from patients having and demanding choice regarding their treatment and care.

• Following a review of services there are plans to develop a team based model that will deliver the services as closely to the patients as possible.

• We are facilitating the development of nurse led services.

• Chemotherapy activity is expected to grow considerably over the next five years and the capacity to deliver this must be addressed. A new £1.7m pharmacy has been opened at the centre with sufficient physical capacity for the forecast activity growth.

Plans for diagnostic imaging The Diagnostic Imaging Service needs to be responsive to the changing demands of referrers, for example the expectation that increased chemotherapy activity will translate into additional demand for imaging, particularly in Computer Tomography (CT).

• The new CT scanner with a multi slice facility will offer a greater quality of image and allow us to undertake certain procedures that we have not be able to do in the past.

• In order to provide a world class service, we want to be able to offer a PET: CT scanning facility (Positron Emission Tomography: Computer Tomography). The Trust has been agreed as a site for the installation of this equipment as part of an independent sector procurement process.

Clatterbridge Centre for Oncology has developed a Human Resources Strategy that places emphasis on four key development areas which are partnership, recruitment and retention, talent management and innovation and modernisation.

E

ffective people management remains at the heart of the organisation’s development as our staff are crucial to our future success.

Particular focus within the short to medium term will be: • Undertaking a review of the management structure • Developing clinical leadership • Developing management capability • Succession planning • Managing a remote workforce • Expanding e-recruitment • Reviewing staff benefits

• Delivering the Electronic Staffing Record • Staff engagement • Staff recognition • Developing a training prospectus • Improving performance and development review levels • Corporate social responsibility • Integrating strands of organisational development A full copy of the Human Resources Strategy is available on request from the Chief Executive Office.

Continuing to pioneer in research and development T

he Trust will continue to conduct high quality research, leading to an increased number of peer reviewed publications and presentations at national and international level. This will be achieved by: • A review of the Research and Development structure at the Trust, aimed at ensuring greater clarity of roles and responsibilities, reduced duplication of effort and increased accountability.

• Collaboration with health service organisations, academic and commercial partners on regional and national programmes of research.

• Undertaking a key role in the development of an Academic Unit of Oncology at the University of Liverpool, leading to an increased collaboration and attraction of external funding.

• Our success in applying for funding for a programme of biological optimisation in Radiotherapy, submitted by the Physics department.

This will increase our ability to attract more commercial income through collaboration with commercial partners both in the radiotherapy field and the pharmaceutical industry.

Annual Review 06 / 07

Looking forward

Service Development Strategy / Annual Plan he Service Development Strategy and Annual Plan demonstrate a future for Clatterbridge Centre for Oncology that is both financially and clinically viable and one in which public interest can be clearly demonstrated.

To deliver this future however, we must change, we must take account of the changes to the environment in which we operate and we must take full advantage of the new local accountability that a Foundation Trust hospital will bring.

5

perfOrManCe

Continuing to deliver safe and effective services C

latterbridge Centre for Oncology will continue to provide a positive patient experience and high quality care. This will be achieved by the professionalism of our staff and the high standards of our facilities, supported by our Service Improvement Team. By using patient feedback and consulting with members we will continually improve the services we offer. The Trust Board has approved an Information Management & Technology Strategy and has revised the governance arrangements to oversee its delivery.

Financing our future Under the developing Payment by Results regime the financial security of

any hospital trust will depend crucially on its ability to contain costs within the income it generates from the operation of its legally binding contracts with commissioners. NHS Foundation Trusts benefit from their independence in deciding how best to deal with these pressures.

It is recognised that the achievement of Foundation Trust status and the increasing financial pressures facing the local health economy will introduce new challenges in financial management with developments required in Trust Board reporting and a greater business focus on medium term business planning.

“By using patient feedback and consulting with members we will continually improve the services we offer”

Meeting national targets T

he Trust has met the following national performance targets:

1

All patients who had suspected cancer and were referred to CCO urgently by their GP were seen within 14 days .4% of patients were treated within 1 days from the time of referral to Clatterbridge Centre for Oncology (target threshold %) No patients wait 0 weeks for elective admission

4 5 6 7

No patients wait 1 weeks for a first outpatient appointment 100% of both elective in-patients and outpatients were fully or partially booked With the exception of one patient in June, no patient has waited longer than seven weeks (target 1 weeks) for imaging services such as CT-scanning and MRI scanning at the Trust We have had only one incident of MRSA bacteraemia (target no more than two)

The 62-day cancer waiting time standard Key risks

T

he delivery of the 6 -day cancer waiting time standard remains a considerable challenge. While performance has improved over the year and we have exceeded the performance threshold of 5% for the last four weeks

C

latterbridge Centre for Oncology has a strong record of achieving its key objectives and continues to review all indicators of performance, acting on these where there is evidence of significant risk. A Board-approved Assurance Framework is in place, assuring the necessary evidence of an effective system of internal control.

The Trust has considered these issues in depth. The actions to limit these risks are highlighted in detail within the Service Development Strategy and Annual Plan.

6

Clatterbridge Centre for Oncology

Yearly quarter

Trust performance 2006/2007

Trust performance 2005/06

Q1 (April – June)

7 .1%

Not recorded

Q (July – Sept)

4. %

51.6%

Q (Oct – Dec)

6%

61.6%

Q4 (Jan – Mar)

.4% (interim)

1. %

Major incident plan W

e have a major incident plan in place which is fully compliant with the requirements set out in NHS guidance ‘Handling Major Incidents’.

Performance

The key risks facing the Trust in the next few years relate to the ‘unknown’ element of Payment By Results. This system will not apply to cancer services until April 00 . A further element of risk has been identified in relation to patient choice and potential competitors for the services that we provide.

of the financial year, achievement of this target remains elusive. This target monitors the maximum waiting time for ‘suspicion of cancer’ patients from the point of urgent GP referral to the start of treatment.

Annual Review 06 / 07

7

Working hard to address the 62-day target

Out-patient first attendances – waiting times August to March Up to 4 weeks / % Up to 13 weeks / % 2006 / 07

Clatterbridge Centre for Oncology is making steady improvements towards meeting the 62-day waiting time for cancer patients.

T

he majority of patients referred to Clatterbridge Centre for Oncology are not affected by the 62-day waiting time target. The figures reported account for 8% of patients treated at the centre. While we accept the importance of improving our work in this area, the Trust is pushing hard to address performance across all areas that affect the remaining 92% of patients.

Our performance in treating patients within 31 days as soon as we receive referrals at the Trust is exemplary, and our radiotherapy waiting times are recognised as among the best in the country at 18 days. These are the figures that affect the majority of our patients who come to receive more than 112,000 radiotherapy and chemotherapy treatments at the hospital every year.

Director of Performance and Improvement Teresa Fenech explains: “Meeting this target is always going to be more complex for a specialist hospital trust like ourselves.

It monitors the waiting time across the entire patient pathway

– from the point of GP referral to a local hospital, through to diagnosis procedures and identifying appropriate treatment before actual referral to our centre. In complex cases, the target can have been breached before we receive referral here to Clatterbridge Centre for Oncology.

“The Trust has acted swiftly to address its performance in the 62-day target and appointed two new members of staff to act as patient navigators. They are currently working with consultant doctors from both our hospital and referring hospitals to put processes in place to allow the earliest appropriate tracking of patients who will need treatment at our centre.”

The Healthcare Commission has also recently announced that tertiary centres can seek reallocation of breaches to referring organisation, where the patient was referred after day 62 (subject to specific criteria and the agreement of secondary care).

2006/07 Total

2005/06

2004/05

17,786 8,516 26,302 25,432 24,782

Radiotherapy attends

61,422 29,302 90,724 94,633 93,343 511

145

656

613

541

In-patient spells 2,871

1,354

4,225

4,508

4,570

Out-patient 35,038 consultations

17,028

52,066

52,188

51,435

Clatterbridge Centre for Oncology

Medical Oncology

1091 / 97.8%

24 / 2.2%

0 / 0

1115

Clinical Oncology

3215 / 98.2%

59 / 1.8%

0 / 0

3274

Totals

4306 / 98.1%

83 / 1.9%

0 / 0

4389

Waiting time in out-patient clinics at Clatterbridge Centre for Oncology Totals

2006/07 / % August to March

2006/07 / % April to July

2005/06 / %

Seen within 30 minutes

5327 / 65.3%

2656 / 70.0%

7321 / 62.3%

31-60 mins

1806 / 22.1%

746 / 19.7%

2651 / 22.6%

60+

1026 / 12.6%

390 / 10.3%

1774 / 15.1%

Waiting time in out-patient clinics at Clatterbridge Centre for Oncology This information is based on figures submitted to the Department of Health First attendances August 2006 to March 2007 Patients seen Patients who ‘Did Not Attend’ (DNA) 6357 368

% DNA 5.5%

Follow up attendances August 2006 to March 2007 Patients seen Patients who ‘Did Not Attend’ (DNA) % DNA 108,170 3768 3.4%

Performance

2006/07 (April-July)

Chemotherapy attends

Proton Therapy

28

2006/07 (Aug-Mar)

Totals

Total seen between April and July 2006: 3792. Total seen between August and March 2007: 8159

Episodes of care Activity

Greater than 13 weeks / %

Annual Review 06 / 07

29

Number of complaints received

The Trust strives to maintain a responsive service and is proud of its record of dealing sympathetically and effectively with anyone experiencing dissatisfaction with our service.

Year 2006/07 2005/06 2004/05 2003/04 2002/03

Amount 1 6 1 1 56

Staff

Equality and Diversity

Improvements in the volume, range and quality of services to patients have been achieved by having the right balance of numbers and skills of staff. In 006/07 the staffing establishment was increased by 6 whole time equivalents (4.5%).

Clatterbridge Centre for Oncology NHS Foundation Trust is committed to promoting equality and recognising the benefits of diversity in its’ roles as a provider of services and as an employer. As such, the Trust has taken the decision to have an Equality & Diversity Scheme rather than a Race Equality Scheme to allow us to encompass a wide ranging set of issues such as age, gender, disability and sexual orientation. This is in line with the Governments’ intention to move towards a single equality body.

This Equality & Diversity Scheme will continue to be developed over the next few years with regular reviews, accompanied by an action plan for specific legislation.

The aims of this scheme are:

OperatinG anD finanCial revieW Operating and financial review

• To set out the principles and key beliefs of the Trust • To clearly outline the Trust’s commitment to all aspects of Equality & Diversity • To mainstream all relevant legislation and ensure that this scheme addresses all forms of discrimination.

0

Clatterbridge Centre for Oncology

Annual Review 06 / 07

1

finanCial suMMarY The Trust has again had a successful year and has achieved or exceeded all of its key financial targets. The Trust’s financial position is detailed in the accounts included as part of this report, however the table below summarises performance in the key areas: Financial Target

Outcome

Planned income & expenditure surplus of £0. 1m

Achieved actual surplus of £1. m

Earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of £ . 0m

Achieved actual EBITDA of £ .61m

I&E surplus margin of .7%

Achieved margin of . %

EBITDA margin of . %

Achieved margin of 10. %

Return of Assets employed of 7. %

Achieved return of .6%

Liquid ratio of 54.4 days (measures liquidity of the Trust.

The higher the ratio the more liquid the Trust)

Achieved ratio of 74.0 days

Overall Financial Risk Rating determined by the independent regulator (Monitor) of 4 (where 5 represents lowest financial risk and 1 highest)

Based on the metrics above CCO would achieve a financial risk rating of 5. However all Foundation Trusts that have been authorised for less than 1 months can only achieve a maximum of 4. Therefore CCO’s rating is capped at 4

Prudential Borrowing Limit (PBL): The long term prudential borrowing limit is set by Monitor. The Trust’s current cumulative long term limit is £11. m

CCO has not taken out any loans in 006/07, therefore net debt is nil. The Trust is within the PBL

Private Patient Income Cap: Under the terms of authorisation as a Foundation Trust private patient income must not exceed . % of total clinical income

Private Patient income of £0. 1m represents just over 1% of total Trust clinical income

Other income and non-healthcare activities A

s noted above the majority of the Trust’s income is derived from providing clinical cancer services. In addition the remaining 15% of income is derived from: • • • •

Undertaking research & development Education and training External drug sales to the private sector Hosting non-clinical services, such as the National Cancer Services Analysis Team, the Merseyside and Cheshire Cancer Network, and Clatterbridge Cancer Research Trust.

The funding for the latter two services transferred to other organisations in 006/07 (1st October and 1st February respectively). Therefore income from hosted services is expected to reduce correspondingly in 007/0 .

However in CCO’s accounts income for these services matches expenditure therefore there will not be an adverse impact on the Trust’s EBITDA overall I&E surplus.

• Support from charities and recharges to other NHS and non-NHS bodies.

Investment Activity T

he Trust invested just under £5 million in new and replacement equipment, Information Technology systems and building refurbishment in 006/07.

The main schemes were: • £1,47 ,000 to introduce a Picture Archiving and Communications system (PACs) to enable diagnostic and radiotherapy planning images to be viewed digitally rather than using film

• £1,071,000 to improve the physical condition of the Trust’s estate • £ 10,000 to replace a linear accelerator (a radiotherapy treatment machine) • £5 ,000 to replace a diagnostic CT scanner with a significantly more technologically advanced model • £47 ,000 to replace an X-ray Simulator with a CT Simulator (used in planning radiotherapy treatment) • £ 71,000 to upgrade the Centre’s IT network.

All of the above represented investments in assets that are protected to deliver cancer services to our patients as part of the core business of the Trust, with the expectation that the improved technology will build on the existing high standard of care provided.

Key financial risks he majority ( 5%) of the Trust’s income is received for the provision of non-surgical cancer treatments to the residents of Merseyside, Cheshire, and parts of Lancashire, North Wales and the Isle of Man. Approximately 5% of the Trust’s clinical income is funded by Payment

by Results (PbR) national tariffs, with the remainder from locally determined

Clatterbridge Centre for Oncology

prices. Both PbR and the local tariff arrangements are based on the principle that the Trust is reimbursed based on activity performed. Therefore a reduction in activity levels represents a financial risk to the Trust. However the Trust is able to mitigate in part against this risk by: • Employing contract tolerances to reduce in year income volatility

• Agreeing cancer drug developments to ensure drug funding based on actual drug usage

Operating and financial review

T

Another key financial risk is the delivery of the Trust’s cost improvement programme (CIP) however the target was achieved in 006/07 and 0% of the 007/0 programme has already been identified.

Annual Review 06 / 07

suMMarY finanCial stateMents

BALANCE SHEET AS AT 31st MARCH 2007 Opening 31st March 2006/07 £000s

Balance 1st August 2006 £000s

0 , 5 0 32,985

0 , 6 0 29,926

411 , 11 0 , 66 11,588

5 , 0 0 5,67 9,868

(10,54 )

( , 76)

1,039

992

TOTAL ASSETS LESS CURRENT LIABILITIES

34,024

30,918

CREDITORS: Amounts falling due after more than one year

(1, 55)

(1,75 )

(5)

(17 )

32,664

28,994

Public dividend capital Revaluation reserve Donated asset reserve Other reserves Income and expenditure reserve

0,55 5,4 6 ,15 0 4,5 7

17, 45 5,7 , 75 0 , 45

TOTAL FUNDS

32,664

28,994

FIXED ASSETS Intangible assets Tangible assets Investments

CURRENT ASSETS Stocks and work in progess Debtors Investments Cash at bank and in hand

INCOME AND EXPENDITURE ACCOUNT FOR THE 8 MONTHS ENDED 31st MARCH 2007

CREDITORS: Amount falling due within one year NET CURRENT ASSETS / (LIABILITIES)

8 months 2006/07 £ 000s Income from activities Other operating income Operating expenses OPERATING SURPLUS / (DEFICIT) Profit / (loss) on disposal of fixed assets SURPLUS / (DEFICIT) BEFORE INTEREST Interest receivable Interest payable Other finance costs - unwinding of discount Other finance costs - change in discount rate on provisions

, 6 ,651 ( 1, 4) 1,7 0 ( ) 1,777 154 0 0 0

SURPLUS / (DEFICIT) FOR THE FINANCIAL PERIOD

1, 1

Public Dividend Capital dividends payable

(65 )

RETAINED / SURPLUS (DEFICIT) FOR THE PERIOD

1,279

PROVISIONS FOR LIABILITIES AND CHARGES TOTAL ASSETS EMPLOYED FINANCED BY:

The Financial Statements on pages 6 to 7 were approved by the Board on 0th May 007 and signed on its behalf.

Signed

Operating and financial review

The summary financial statements below are a summary of the information contained within the full accounts of the Trust. Requests for copies of the full accounts should be made to: Mr John Andrews, Acting Director of Finance, Clatterbridge Centre for Oncology NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral, CH6 4JY. The full annual accounts for the Trust can also be viewed on our website www.ccotrust.nhs.co.uk

Date: 0th May 007

A Cannell Acting Chief Executive

4

Clatterbridge Centre for Oncology

Annual Review 06 / 07

5

CASH FLOW STATEMENT FOR THE YEAR ENDED 31st March 2007

STATEMENT OF TOTAL RECOGNISED GAINS AND LOSSES FOR THE 8 MONTHS ENDED 31st March 2007

8 Months 2006/07 £ 000s

Surplus / (deficit) for the financial year before dividend payments

1,931

Fixed asset impairment losses

0

Unrealised surplus / (deficit) on fixed asset revaluations / indexation

0

Receipt of donated asset

0

Reductions in the donated asset reserve due to depreciation

(217)

Additions / (reductions) in “other reserves”

0

Other recognised gains and losses

Total gains and losses relating to the financial period

0

8 Months

2006/07

£ 000s OPERATING ACTIVITIES Net cash inflow / (outflow) from operating activities 3,240 RETURNS ON INVESTMENTS AND SERVICING OF FINANCE: Interest received Interest paid Interest element of finance leases

154 0 0

Net cash inflow / (outflow) from returns on investments and servicing of finance

154

Taxation paid / received CAPITAL EXPENDITURE Payments to acquire tangible fixed assets Receipts from sale of tangible fixed assets Payments to acquire intangible fixed assets Receipts from sale of intangible fixed assets

(2,344) 7 0 0

Net cash inflow / (outflow) from capital expenditure

(2,337)

DIVIDENDS PAID

(978)

Net cash inflow / (outflow) before management of liquid resources and financing

79

MANAGEMENT OF LIQUID RESOURCES Movement in short-term deposits

0

Net cash inflow / (outflow) before financing

79

1,714

Total gains and losses recognised since last annual report

1,714

Public Dividend Capital received 2,608 Public dividend capital repaid 0 Government Grants received 0 Other capital receipts 0 Capital element of finance lease rental payments 0 Net cash inflow / (outflow) from financing 2,608

Increase / (decrease) in cash 2,687

36

Clatterbridge Centre for Oncology

Annual Review 06 / 07

Operating and financial review

FINANCING

37

BOarD Of DireCtOrs

BOarD COMMittees

The Board of Directors has responsibility for setting the strategic direction of the Trust and for understanding and managing significant risks. The Board also receives assurance that the Trust is fulfilling its responsibilities including compliance with standards and targets.

Members of the Board who also have membership of the Board Committees are listed below:

Chief eXeCutive anD eXeCutive DireCtOrs

Audit Committee

Tony Halsall –

Andrew Cannell –

Dawn Jennings

Teresa Fenech –

John Andrews –

Helen Porter –

Dr David

To provide the central means by which the Trust Board ensures effective internal control arrangements are in place. In addition, the Audit Committee provides a form of independent check upon the executive arm of the Board.

It does this by holding regular meetings in which Internal and External Auditors are in attendance.

Chief Executive

Director of

– Director

Director of

(Acting Director

Director of

Husband –

(up to 28th

Finance (Acting

of Human

Performance &

of Finance

Healthcare

Medical Director

February 2007)

Chief Executive

Resources

Improvement

from 1st

Governance

from 1st

Nomination Committee The Nomination / Appointment Panel for a Chief Executive is made up of the Non-Executive Directors. The appointment is subject to the approval of a majority of the members of the Council of Governors present and voting at a general meeting.

The Nomination / Appointment Panel for the Directors is made up of a committee consisting of the Chairman, the Chief Executive and the other Non-Executive Directors.

During 006-07 the Board was required to appoint a new Chief Executive Officer.

The process for the appointment of the Chief Executive was: Assessment Day – 7th March 007 Formal Interviews – 16th March 007 Reported to the Council of Governors for approval – 6th March 007 Interview Panel: Chairman, x Non-Executive Directors, x Council of Governors and 1 External Chief Executive.

This followed the appointment process outlined in the Trust’s constitution.

Membership: Non-Executive Directors only, excluding the Chairman.

March 2007)

March 2007)

Chair anD nOn-eXeCutives

Alan White –

Douglas

Andrea

Carol

Chairman

Buchanan –

Spyropoulos –

Eastwood –

Vice Chair

(up to 31st

(from 1st

January 2007)

February 2007)

Clatterbridge Centre for Oncology

Louise Martin

The Remuneration Committee of the Chairman and other Non-Executive Directors decide the terms and conditions of office including the remuneration and allowances of all the Directors, including pension rights and any compensation payments.

Vicky Tagart

Graham Morris

“As a Foundation Trust hospital we have a clear vision, set out in our Service Development Strategy, about where we want to be five years from now.”

Andrew Cannell, Acting Chief Executive

Operating and financial review

Remuneration Committee

Membership: A White, D Buchanan, L Martin, A Spyropoulous (up to 1st January 007), C Eastwood (from 1st February 007), V Tagart, G Morris.

Annual Review 06 / 07

fOunDatiOn trust GOvernOr

anD MeMBership infOrMatiOn

Constituency

Term of office

Committees in addition to Council of Governors

Andrew Cartwright (from March 007) Michele Christopherson Kerry Connon Reg Cox (from November 006) Mary Doddridge

Wirral, Wales and the rest of England Sefton Sefton Liverpool

007

Strategy

00 007 007

Patient Strategy Membership

Liverpool

007

The Council is made up of six Staff Governors (elected by staff) and 15 Public Governors (elected by the members).

There are also six Governors from nominated organsiations, serving a fixed three year term of office.

Joanne Evans Tom Fisher

007 00 00

Fundraising

The Council of Governors meets quarterly in public and fulfils its legal obligations as outlined in the constitution.

Linda Irlam Hazel Maddox Ruth Murray

Liverpool Wirral, Wales and the rest of England Wirral, Wales and the rest of England Warrington & Halton St Helens & Knowsley Chester, Ellesmere Porter and Vale Royal Chester, Ellesmere Port and Vale Royal Wirral, Wales and the rest of England St Helens & Knowsley

Membership and Strategy Patient Patient

007 00 00

Membership Membership Patient

00

Membership

007

Strategy

007

Patient and fundraising

Warrington & Halton

00

Patient

Non staff Doctor Non clinical Other clinical Radiographer Nurse

00 007 00 007 00 00

Patient Patient and Strategy Fundraising Fundraising and Strategy Strategy Patient

Manx Cancer Help Association Macmillan Cancer Support Wirral Council University Hospital Aintree Cancer Task Force

00

Patient

00 00 00 00

Strategy Patient

University of Liverpool Liverpool PCT

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On August 1st 006 Clatterbridge Centre for Oncology became a Foundation Trust Hospital.

This means the Trust now operates independently of the Department of Health and it is accountable to its patients and the local community. It remains part of the NHS, but we now have greater freedom and flexibility in determining how services are run in order to best meet local needs.

Local people, patients, carers and staff can become members and elect representatives to serve on a Council of Governors for the Trust. Over 4, 00 people have already applied to become members of Clatterbridge Centre for Oncology NHS Foundation Trust.

Chairman Alan White said: “We see this as a real opportunity to establish even closer links with the communities that we serve. The Council of Governors will play a crucial role in bringing about wider community engagement. Patients, staff and residents will have a much greater say in how cancer services are developed and delivered across the region.”

Council of Governors

The Governors The Governors are elected as part of an independent process managed by Electoral Reform Services, in line with the Trust constitution.

In addition to Council meetings, the group has also established four committees – Membership and Communications, Patient Experience, Fundraising and Strategy.

Governor

Elected

June Holland

Gill Oliver Susan Ramsay Margaret Warriner (from March 007) Hilda Whitfield

Staff

Alan White, Chairman

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Clatterbridge Centre for Oncology

Nominated Eve Berridge (from November 006) Nicola Cook John Cocker John Earis Ray Murphy (from January 007) Alistair Watson Ewan Wilkinson

Operating and financial review

“With the support of our Council of Governors we have high hopes and expectations about what the future holds.”

Peter Benson Doug Errington Peter Fearnhead Philip Mayles Kate Perkins Kate Smith

Strategy

Strategy

Annual Review 06 / 07

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aCKnOWleDGeMents We would like to express our thanks to former public Governor Tina Freeman, and former nominated Governors Stephen Parry and Stephen Cropper. Each served as a Governor during 006/07 for period of time, but they have since resigned from their roles.

The Nominations Committee followed the appointment process described in the Trust’s constitution for the appointment of Dr Carol Eastwood in December 006.

This appointment was approved by the Council of Governors at its meeting in January 007.

We would like to offer our sympathies to the family of former Governor William Beedles, who sadly passed away at the end of 006.

Working together with the Board Every effort is being made to ensure close working links between the Tuust Board and the Council of Governors.

Minutes from the Council of Governors meeting go to the Trust Board and both Executive Directors and Non-Executive directors attend the Council of Governor meetings and its committees.

Nomination / Appointment Panel The Nomination / Appointment Panel for the Non-Executive Directors is made up of the Chairman and three elected Governors. This Nomination Panel is responsible for appointing Non-Executive Directors by identifying appropriate candidates through a process of open competition, which take account of the policy maintained by the Council of Governors and the skills and experience required.

Membership: A White, T Fisher, D Errington, M Doddridge.

Foundation Trust Membership Every Member is either a member of one of the public constituencies or a member of one of the staff constituencies.

Membership is open to any individual who is over the age of 16, is entitled under the constitution to be a member of one of the public constituencies or the staff constituencies and has completed the relevant application form.

Charitable donations Our thanks and gratitude must go to our loyal and dedicated fundraisers for all their support and contributions over the last year.

Clatterbridge Cancer Research Trust We would like to express our gratitude to Clatterbridge Cancer Research Trust for their continued support in contributing towards vital research and development at the hospital.

WRVS (Womens Royal Voluntary Service) We would like to thanks the WRVS who continue to play a crucial role in providing essential facilities where staff, patients and visitors can relax and enjoy refreshments away from the wards and waiting areas.

If members wish to contact their individual Governor or a Director they can do so by contacting Andrea Leather, Corporate Governance Manager on 0151 4 77 or by emailing andrea.leather@ccotrust.nhs.uk

Public Patient Involvement and Patient Council Our grateful thanks must go to the Public and Patient Involvement Forum and the Patient Council involved with the work of the hospital. These groups have regular meetings to ensure that patients and members of the public have a much greater input into decisions that affect the health of the community that Clatterbridge Centre for Oncology serves.

There is a ‘members only’ section available on the CCO website.

Useful contacts

Constituency details Staff constituency members as of March 1, 007 totalling 7 7.

Public constituency members as of March 1, 007 totalling 465.

Doctor Nurse Non clinical Other clinical professional Radiographer Volunteer

Wirral, Wales and rest of England Liverpool Sefton Warrington and Halton St Helens and Knowsley Chester, Ellesmere Port and Vale Royal

45 1 1 11 104 1 1 1 5

Clatterbridge Centre for Oncology Volunteers We would like to express our sincere thanks and appreciation to the Clatterbridge Centre for Oncology volunteers who continue to provide an indispensable service to our patients, visitors and staff.

1 60 464 67 77 6 5

Fundraising If you want to find out more information about how to get involved with fundraising activities for the Trust, or to make a charitable donation, please contact the Fundraising office on 0151 4 7 4 .

Becoming a volunteer Anyone interested becoming a member of the volunteer network at Clatterbridge Centre for Oncology should contact Volunteer Co-ordinator Alison Bell on 0151 4 1155 ext 4 64.

Applying for jobs To find out more information about job vacancies at Clatterbridge Centre for Oncology visit www.jobs.nhs.uk or contact Human Resources on 0151 4 767 .

Foundation Trust membership Anyone interested in becoming a member of Clatterbridge Centre for Oncology NHS Foundation Trust can either apply on line by visiting www.ccotrust.nhs.uk or telephone 0151 4 77 .

Membership strategy The Membership and Communications committee is responsible for reviewing and implementing the Membership Strategy.

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Clatterbridge Centre for Oncology

Annual Review 06 / 07

Operating and financial review

The Council of Governors has approved its standing orders which includes the development of its sub committees.

Each of these committees has identified Executive and Non-Executive Director. In addition the Director of Healthcare Governance has a specific role in supporting and working with the Council of Governors playing a key role in developing links between the board committees and the Council of Governors ensuring that key strategic themes are being addressed. The Council of Governors receives minutes of the Public Board meetings.

Expressing our appreciation

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Registered Charity Number 1051727 Clatterbridge Centre for Oncology Clatterbridge Road Bebington, Wirral CH63 4JY Telephone: 0151 334 1155 www.ccotrust.nhs.uk

Large print and Braille versions or translations of this document are available on request